Ethical dilemmas often arise as a consequence of having dementia or caring for a person with

dementia which are difficult to resolve. Sometimes problems seem insurmountable and it is
difficult to decide what to do because it is not clear what is right or wrong, ethical- ly
speaking. I am therefore very pleased to present this report on ethical dilemmas faced by
carers and people with dementia. It will hopefully help people with dementia and their carers
to understand ethical dilemmas, approach them more confidently and feel more at ease with
any decisions that might be made.

Dilemmas and ethical dilemmas

A dilemma literally means a problem offering two possibilities, neither of which is
acceptable. People in mod- ern Western societies may be familiar with the idea of dilemmas
because of a tendency to think in either/or terms (i.e. something is good or bad, possible or
impossible, a person is happy or sad, agrees or disagrees etc.). However, many dilemmas
have more than two unacceptable outcomes. So, technically speaking, we should really call
them trilemmas and polylemmas but for the sake of simplicity we will stick to the wellknown term dilemma.
An ethical dilemma is a situation in which moral principles or values are in conflict. This
makes it difficult to interpret or decide what would be the right or wrong course of action or
attitude to take. In addressing ethical dilemmas, we are deliberately focusing on some of the
more problematic aspects of living with dementia but with the aim of enabling readers to
address these more positively and with greater confidence. Before looking at ways to deal
with ethical dilemmas, it is helpful to reflect on what is meant by ethics and how should we
decide what is right and wrong.

Theories about what is right and wrong

When trying to decide what is right and wrong, we tend to rely on systems or structures of
thought and belief that help us to reflect systematically and critically on human behaviour.
Such deliberations are usually based on normative perspectives (shared norms and
understandings) of good and bad; we therefore rely on values which are socially defined.
However, at the same time we should be able to reflect critically and with compassion about
what is right and wrong in a particular situation and draw our own conclusions. This may
sometimes lead us to challenge the way that values are defined and interpreted within society.
Philosophers have debated these issues for centuries and have developed a number of ethical
standards based on a range of theories. From some of the main theories, the following criteria
have been put forward to deter- mine what would be a good or the right action or
approach, namely:

 that which results in the most pleasure and the least pain to those affected (utilitarian
approach),
that which best protects and respects the moral rights of those affected (rights-based
approach),
that which treats everyone equally or if unequally then fairly, based on a standard that is
defensible (fairness approach),
that which is defensible based on outcomes, which would maximise peoples happiness or
welfare (conse- quentialist approach),
that which contributes towards the good of the community (common good approach),
that which is consistent with what a virtuous person would do (virtue approach),
that which is in accordance with our duties as rational individuals living in interdependent
societies (deon- tological approach).

Ethical principles and values

Another approach to determining what is ethical is to consider ethical principles or values.

According to the principlist approach, a person can be said to have behaved ethically if they
have respected certain principles. A few decades ago a set of four principles was developed
by Beauchamp and Childress (9), namely, respect for autonomy, beneficence (i.e. doing
good), non-maleficence (i.e. avoiding doing harm) and justice/equity. They were intended to
serve as a framework to guide professional medical ethics but have since been applied in a
wide range of contexts. There are also other principles and values which are perhaps equally
important in other contexts (e.g. in everyday interactions with other people, in relationships
with friends and family, in social care, and in residential care settings) such as
trustworthiness, honesty, integrity, compassion, well-being, confiden- tiality and respect for
privacy, personhood and dignity.

Ethical Dilemmas in daily Life :

Every day in our life we faced Dilemmas. We dont understand what we should do at this
moment. Sometimes we want to justify what is right or wrong but in the same time there have
been two side opinions.
One side its wrong and other side its right and at the same time one side wrong and other
side right.

For example now i want to talk about my daily life some ethical dilemmas.
Im Customer Manager of Grameenphone Telecommunication Sector. (Customer Service
Centre).
1) Case no -1
500/600 customer daily visits in our centre for services. Here a Queue Machine, we
give customers Token. Here is the 8 counters for sim related services and 3 for
internet services.
Sometimes our friends and Family also visited for their problem solving and other
services.
At this time we are feeling hastier for giving him token. Because there have been
many customer waiting for getting their services. so we dont want to wait our friend
and relative .
At the same time this is totally wrong at our Working rules. Because every customers
are same.
2) Case no-2
In our customer service Centre we have some rules for giving sim to the customers. If
the rules are matched than we can give sim to customers.
Like- Fnf no, sim pack, Last recharge .
Sometimes few customers who (60-70) years old. Who didnt know about anything
but in our judgement he is the main owner of this sim . but for rules and regulation we
could not give the sim.
If i give the sim than its totally non compliance. And if i dont give the sim than its
mentally dissatisfaction.
3) Case no-3
At my workplace many time i faced the problem. My team mate some time
mistakenly doing wrong.
Like replace wrong number than customer came to the office for complain.
If i talked with my supervisor than my team mate will be terminated for this job. and
if i dont talk than he will again do this, which is totally customer harassment.
In this moment its totally tough to take diction, what should I do ?
In our company there are for values which are very much important.
1)keep promises
2)make it easy

3)be respectful
4).
So we can not broke any vales. At the same time we faced some dilemmas.

The term ethics refers to standards which tell us how we ought to act in various situations
and how we ought to live with one another. This is often framed in terms of rights,
obligations, duties, benefits to society, fairness or specific virtues (4). The standards of
behaviour are based on perceptions of right and wrong or good and bad. Ethics is not just
about big societal issues such as immigration, war, abortion or euthanasia which are
discussed in the media. Often, everyday matters such as whether it is reasonable to ask for
help, how to respect a persons dignity, how to promote autonomy or what to do if a person
repeatedly refuses to get washed also have an ethical dimension.
Familiarise yourself with some of the key ethical principles and values .Some people consider
some principles and values as being more important than others. Our view is that this might
vary between people and across different circumstances. It is therefore important to know and
understand the people affected by a particular ethical dilemma. If the person with dementia is
unable to express what is important, try to find this out from people who know the individual
well. A statement of values can also be very helpful. This is a document which can take any
form but generally includes information about what is meaningful and important to someone
in life, their likes and dislikes, values, guiding principles and beliefs. As there may be several
people affected by a particular issue, it is possible that people will have different priorities.
Therefore, we need to consider the views of all involved. Certain issues, such as vulnerability
and dignity, might not immediately occur to people but may threaten their future wellbeing if
not addressed. Sometimes there will be an elephant in the room and it may take courage to
draw attention to an issue that everyone is choosing to ignore.
Ethical dilemmas are not about making one-off decisions. It is therefore important to consider
situations, any decisions made and subsequent changes over a period of time. The ethical
dilemma and attempts to resolve it may have had an impact on the family dynamics and on
individual relationships. Similarly, the resolution of the dilemma may have contributed
towards a different situation which will gradually unfold and may lead to other issues which
will affect peoples lives. It may be helpful to reflect on these issues and their implications
and especially with hindsight to learn from the experience, bearing in mind that you did your
best.